Overpronation is when the foot and ankle roll too far inward when you walk. This movement strains the muscles, tendons, and ligaments in your feet and legs. As a result, you develop pain, limited movement, and many conditions like shin splints, sprained ankles, and plantar fasciitis.
Flatfeet often cause overpronation. However, the problem may arise due to weak and imbalanced muscles and conditions like posterior tibial tendon dysfunction. Overpronation usually improves with custom orthotics, supportive taping or braces, and exercise therapy.
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What is Overpronation?
Every time you take a step, you land on your heel, and the foot rolls slightly inward (pronates). This natural movement distributes your weight evenly from the heel, across the foot bones (metatarsals), and to your toes.
Overpronation occurs when the foot rolls too far inward as your weight transfers from your heel to your toes. This movement transfers your body weight to the inner edge instead of spreading it over the ball of the foot. Then, the big toes take on too much pressure as they push off the ground.
During overpronation, the arch flattens. As a result, it can't absorb shock and muscles and tendons take on extra stress. Your ankle may also roll inward, placing excessive pressure on the ligaments.
Causes
Overpronation can be caused or worsened by flatfeet. However, weak, injured, stretched, or imbalanced muscles may also cause the problem.
Muscle you don't suspect may contribute to overpronation. For example, your hip muscles stabilize the pelvis, which keeps your legs and feet in alignment when walking. Weak hip muscles may increase your risk of overpronation.
Some people have overpronation because their feet and ankles are too flexible, so they tend to have more movement.
Flatfeet
Children may have overpronation due to flat feet. However, most outgrow the condition as they gradually develop stronger arches.
Adults can develop flatfeet, a condition called progressive collapsing foot deformity (PCFD). Risk factors for PCFD include:
- Midfoot arthritis
- Weak ligaments
- Overweight
- Posterior tibial tendon dysfunction (PTTD)
- Overuse injuries (repetitive, impactful movements like running)
- Age, particularly being over 40
Women also have a higher risk of PCFD than men.
Signs and Symptoms
Some people with overpronation have no symptoms at all. Others may experience pain, stiffness, or weakness in their legs and feet.
Overpronation isn’t a medical condition; it’s a movement pattern. But over time, that pattern can increase your risk for certain medical conditions because it strains the muscles, joints, and ligaments in your feet and legs.
In some cases, the disorders caused by overpronation may be the first sign of the movement problem. The conditions that are commonly associated with overpronation include:
- Heel pain
- Shin splints
- Ankle sprains
- Plantar fasciitis
- Achilles tendon pain
- Bunions
- Knee pain, including patellofemoral pain syndrome
- Pain in the iliotibial band (IT band)
- Lower back pain
- Arthritis in foot and ankle joints
- Posterior tibial tendonitis
- Stress fractures
You might also experience pain in the midfoot or hips, which can be symptoms of flatfeet.
How to Tell You Have Overpronation
The only way to be sure you have overpronation is to get a gait and foot posture evaluation from your healthcare provider. However, there are three ways to help you identify the problem:
Look at the wear pattern on your shoes: If your shoes are more worn down on the inner side than the outer side, you probably overpronate.
Do a wet-feet test: Wet the bottom of your foot and then step on a paper towel (on a hard floor). If the arch area is wet, there’s a good chance you overpronate.
Ask someone to watch you walk: They should sit on the floor behind you and watch as you walk forward (away from them). Depending on the severity of your overpronation, they may be able to see that your foot (and ankle) roll inward (toward the center of your body).
When to See a Healthcare Provider
If you have overpronation but no symptoms, you don’t necessarily need to see a healthcare provider. But you should consult a healthcare provider if you have:
- Pain in your arch or along the inside of your foot
- Pain on the outside of your ankle
- Persistent pain in your legs, hips, or lower back
- Difficulty with walking, standing, running, or balance
- Weakness when standing on your toes
- Frequent foot injuries
- Recurrent ankle sprains
Diagnosis
To diagnose overpronation, your healthcare provider will take a medical history, learn about your symptoms, and do a complete physical exam. They will also:
- Examine your foot and leg muscles and joints for strength, flexibility, and range of motion
- Check your arches
- Evaluate your gait (watch you walk)
- Perform a foot posture assessment
- Ask you to do movements like a single leg heel raise
Treatment
The goal in treating overpronation is to take the strain off muscles in the foot, ankle, and leg in order to avoid symptoms like pain in the heel, ankle, knees, hips, or back.
The most common treatments for overpronation are wearing supportive shoes or insoles. Exercises and stretches can also help. Rarely, you may need surgery to correct flatfeet that can cause overpronation.
Supportive Shoes
The first course of treatment for overpronation is to wear more supportive footwear. This can include specialized shoes or inserts that support the foot and arch while reducing ankle movement. People with overpronation should look for shoes that have firm support in the heel and mid foot. This will help prevent too much movement.
Taping and Bracing
Kinesiology taping and bracing can support your foot and reduce or prevent overpronation.
Orthotics
If you have moderate or severe overpronation, your healthcare provider might recommend custom orthotics. Prescription orthotics improve overpronation by providing excellent support to the foot, arch, and ankle.
You can purchase orthotics from shoe stores and pharmacies. However, they're not designed to correct problems and stabilize your foot. Custom orthotics are designed to fit your feet and provide individualized support.
Exercises and Stretches
Exercises and stretches can also help with overpronation. A 2020 study found that exercises targeting the feet, core, and hips helped correct pronation over nine weeks. The exercises included:
- Toe pickups in which you grab small objects with the toes and move them from one place to another
- Flexing and pointing the toes by using a resistance band placed around the toes, similar to a towel calf stretch
- Hip abduction exercises to target the hip and glutes
- Abdominal and oblique muscle (muscles along the sides of your torso) exercises to stabilize the torso
An exercise called the short-foot exercise is also effective for overpronation. In this exercise you raise the arch of your foot off the ground, drawing your toes toward your heel.
Surgery
Rarely, someone with severe overpronation will need surgery to treat flatfeet. Reconstruction realigns the bones to better support the arch and reduce overpronation. A metal implant is used in surgery for flatfeet to stabilize the area.
Surgery can also be used to repair torn tendons, PTTD, or other damage that is contributing to overpronation.
Outlook
Most people can overcome the problem of overpronation with supportive shoes, orthotics, and exercises. In severe cases, you may need to modify your activities, limiting or avoiding those that cause pain or put excessive stress on your foot.
Summary
Overpronation is a movement pattern in which the foot rolls excessively inward. The rolling may cause the arch to collapse, or an existing flatfoot may cause the overpronation. You may also have weak, damaged, or imbalanced muscles, tendons, and ligaments.
Overpronation puts excessive strain on your feet and legs. Without treatment, this condition can cause many problems, such as shin splints, plantar fasciitis, sprained ankles, and arthritis. Supportive shoes, orthotic inserts, and exercises are the most common treatments for overpronation. Some people with severe overpronation may require surgery.
